Context: Online patient discussion forums are important in helping myelodysplastic syndrome (MDS) patients and caregivers navigate the disease and treatment journey. These forums can uncover patient information gaps or needs. Access to therapies and cultural backgrounds influence perceptions of health and disease management approaches. Patient interactions may also identify similarities and cultural nuances of MDS patients across countries. Objective: To understand what conversations from online forums of MDS patients and their caregivers convey about their needs as they navigate the disease and treatment journey. Design: We leveraged Artificial Intelligence and Natural Language Processing (NLP) to algorithmically analyze over 20,000 public, anonymous online comments from 2011 to 2019 to understand the motivation of MDS patients and caregivers from the US, UK, Canada, and China. The NLP algorithm generates a Network that organizes large volumes of unstructured data into topics based on semantic similarity. Results: Seven overarching motivations were extrapolated. “Emotional” refers to receiving/providing emotional support to other patients. “Treatments” relates to treatments, including regimes and decisions. “Transplants” includes the benefits, risks, and experience of transplants. “Clinical” relates to diagnosis, progression, and monitoring. “Education and Logistics” focuses on learning about the disease and care options. “Physical” highlights management of symptoms and treatment side effects. “Diet and Lifestyle” focuses on diet changes and other aspects of living with MDS. The analysis of 20,000 posts detected different motivations but also universal similarities in MDS narratives across countries. In the US, the top conversation driver indicated that patients seek out those with similar cytogenetics profiles, MDS types, or diagnoses. In contrast, in the UK, emotional support was a top motivational driver for patients and caregivers. In Canada, the conversation was driven by patients asking others for specific treatment experiences to evaluate their treatment options. Conversely, patient posts in China indicated that patients are more focused on understanding the disease. Conclusions: The findings suggest that there are unmet information and support needs among MDS patients and caregivers. These include disease/treatment information, support, adequate information sources, and overall guidance to navigate patients through their journey. Greater healthcare professional awareness of these gaps may improve patient care.